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Flashcards in Paediatrics Deck (125)
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1

What are the components of the APGAR score and when is it performed?

Appearance
Pulse
Grimace
Activity
Respiration
Performed at 1st and 5th minute of life

2

Outline the components of APGAR that would score 0 for each domain

Appearance: blue all over
Pulse: absent
Grimace: absent
Activity: absent
Respiration: absent

3

Outline the components of APGAR that would score 1 for each domain

Appearance: blue in extremities, pink body
Pulse: less than 100
Grimace: only on aggressive stimulation
Activity: some flexion
Respiration: slow, irregular

4

Outline the components of APGAR that would score 2 for each domain

Appearance: pink all over
Pulse: over 100
Grimace: cry on stimulation, coughs well
Activity: flexes arms and legs, resists extension
Respiration: strong cry

5

What are the ranges of a normal APGAR score?

8-10

6

List aetiology/risk factors for neonatal sepsis

Ascending infection from mother (chorioamnionitis)
Group B Strep
E. coli
Coag -ve Staph
H. influenzae
Listeria
Pre-labour membrane rupture
Prematurity
Parenteral antibiotics used in mother

7

List clinical features of neonatal sepsis

Seizure
Stiff limbs
Cyanosis
Cap refill greater than 3s
Temp less than 35.5 or over 37.5
Difficulty feeding
Severe chest indrawing
Resp rate over 60
Lethargy

8

Neonatal sepsis is defined as early onset if it occurs when?

First 48-72h of life, mainly due to bacteria acquired before and during delivery (Group B Strep)

9

What investigations would you order for neonatal sepsis?

Bloods: FBC, CRP, culture, glucose
Swab virology
LP for gram stain, cell count, protein, glucose
Urine and stool culture/microscopy

10

Outline management of neonatal sepsis

IV benzylpenicillin + gentamicin empirically
Vancomycin/teicoplanin/amoxicillin

11

List aetiology/risk factors for neonatal seizures

Reduced PaO2
Infection
Hypoglycaemia
CNS injury (haemorrhage, hydrocephalus)

12

Outline management of neonatal seizures

ABCDE approach, turn on side
EEG and ECG monitoring
IV phenobarbitol
Phenytoin/clonazepam/lorazepam
Pyridoxine

13

Jaundice after 24h is usually physiological. Why?

Immature liver can't process high Br
Increased RBC breakdown
Starts at day 2, peaks at day 5, resolves by day 10

14

Visible jaundice on day 1 of life is always pathological. True/False?

True

15

List causes of jaundice on day 1 of life

Rhesus haemolytic disease
ABO incompatibility
G6P deficiency
Spherocytosis

16

Define prolonged jaundice in a neonate

Lasts over 14 days in a term baby or 21 days in a preterm baby

17

List causes of prolonged jaundice in a neonate

Infection
Exclusive breastfeeding
Hypothyroidism
Cystic fibrosis
Biliary atresia
Galactosaemia

18

List clinical features of neonatal jaundice

Yellow tinge to skin/sclera
Drowsiness
Short feed
Altered tone
Seizures

19

What investigations would you do for neonatal jaundice?

Serum Br if less than 35w gestation or less than 24h old
Br using TCB if over 35w gestation or more than 24h old
FBC, blood groups and film
Coombs test (rhesus haemolysis)

20

Outline management of neonatal jaundice

Phototherapy using plasma Br treatment guide
IV Ig may be warranted
Exchange transfusion via umbilical vein/artery prevents further increase in Br

21

What is kernicterus?

Br -induced brain dysfunction

22

List clinical features of kernicterus

Sleepy
Poor suck
"setting sun" lid retraction
Odd movements
Cerebral palsy
Deafness
Low IQ

23

What is the pathophysiology of rhesus haemolytic disease?

RhD- delivers RhD+ baby and may produce anti-D IgG against RhD (isoimmunisation) if blood mixes
In subsequent pregnancy, these antibodies may attack a RhD+ foetus

24

List aetiology/risk factors for rhesus haemolytic disease

Threatened miscarriage
Antepartum haemorrhage
Mild trauma
Amniocentesis, CVS

25

List clinical features of rhesus haemolytic disease

Jaundice on day 1 of life
Yellow vernix
Heart failure
Hepatosplenomegaly
Bleeding
CNS dysfunction
Kernicterus
Stiff, oedematous lungs
Hydrops fetalis

26

Outline management of rhesus haemolytic disease

Keep baby warm
Exchange transfusion
Phototherapy
Anti-D Ig for Rh- mother
Hydrops fetalis: ventilate if required, vitamin K

27

What is neonatal respiratory distress syndrome?

Increased work of breathing due to insufficient surfactant, potentially leading to respiratory failure

28

List aetiology/risk factors for neonatal respiratory distress syndrome

Prematurity
Maternal diabetes
Males
2nd twin
C-section delivery

29

List clinical features of neonatal respiratory distress syndrome

Worsening tachypnoea (RR over 60)
Increased effort, grunting
Cyanosis
Nasal alae flaring
Intercostal recession

30

Outline management of neonatal respiratory distress syndrome

Wrap warmly, incubator
Monitor ABG's, give O2, support ventilation
Prenatal betamethasone/dexamethasone may prevent RDS
Give surfactant via ET tube